Expanded-Coming-Out-Proud Group on Reducing Self-stigma for People With a Severe Mental Illness- A Randomized Control Trial With Six-month Follow-up

September 4, 2026 updated by: Daniel Young, City University of Hong Kong

Globally, approximately one-third of people with severe mental illness report self-stigma. Self-stigma negatively affects recovery by lowering quality of life, self-esteem, and self-efficacy, and reducing treatment adherence, which can lead individuals to refuse psychiatric medication, experience increased psychiatric symptoms, and relapse. Multi-component interventions, which combine several single interventions, have been found to produce better outcomes than single interventions alone, but few studies have been conducted in this area.

To address this research gap, this study aimed to develop and evaluate the longer-term impact of a 12-session Expanded Coming Out Proud (ECOP) group delivered by a social worker and a peer support worker, with skills in empowerment and transforming negative self-stigmatising beliefs, to reduce self-stigma in people with severe mental illness in Hong Kong.

This study was a multicentre, randomised controlled trial with 6-month follow-up. The intervention group received ECOP in addition to treatment as usual (TAU), which included interest classes and recreational activities, while the control group received TAU.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

This study was a multicentre randomized controlled trial. Participants were recruited from four community-based mental health centres in Hong Kong through open recruitment via promotional activities and referrals from these centres. Those who consented to participate were randomly assigned to either the treatment or control group using computer software administered by a research team member who was not involved in data collection or implementation of the ECOP group. Block randomisation was used to ensure equal numbers in the treatment and control groups. The control group received treatment as usual (TAU) provided by a community mental health centre, including interest classes and recreational activities. In addition to TAU, the intervention group received an ECOP group led by an experienced social worker and a peer social worker from a community mental health centre. A research assistant who was blinded to the randomized allocation of participants conducted data collection and outcome assessment with standardized assessment tools at baseline, post-treatment, and at 3-month and 6-month follow-ups

The ECOP incorporated the advantages of both cognitive behavioural therapy and the Coming Out Proud. On one hand, the ECOP, based on the cognitive behavioural therapy, helped participants learn skills to transform self-stigmatising beliefs to reduce self-stigma. On the other hand, the ECOP, adapted from the Coming Out Proud, empowered them to face social stigma effectively by disclosing their mental illness to appropriate social systems, such as peers, support groups, and the media, with an appropriate level of self-disclosure. The ECOP consisted of 12 group sessions, one per week, each lasting one and a half hours, led by an experienced social worker and a peer support worker.

Participants in the control group received TAU, including interest classes and leisure activities provided by collaborating community mental health centres, which were the same as those received by the intervention group.

For all analyses, two-tailed p values of < 0.05 is considered statistically significant. Data analyses will be performed using SPSS 29.0 (IBM Corporation, 2024). For hypotheses (1) and (2), within group intervention effects on all outcome assessment scores were investigated by using repeated measures of analysis of variance (ANOVA), while between group intervention effects were investigated by using group x time repeated measures of ANOVA. Effect sizes were calculated using partial η2, with values of 0.01, 0.06 and 0.14 considered small, moderate and large effects, respectively (Cohen, 1988). For hypothesis (3), the predictive power of the improved ISMI and PESAS scores from pre-intervention to post-intervention on the improved BDI and RSE score were investigated and compared using multiple linear regression analysis, using stepwise selection procedure to investigate the relative predictive power of the improved ISMI score and PESAS score.

Study Type

Interventional

Enrollment (Actual)

80

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Hong Kong
    • Hong Kong
      • Kowloon Tong, Hong Kong, Hong Kong
        • City University of Hong Kong

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  1. aged 18 years or older;
  2. diagnosed with a mental illness by their medical officers according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition, Text Revision) (American Psychiatric Association, 2022); and
  3. receiving community mental health services provided by collaborative local non-governmental organisations

Exclusion Criteria:

  1. having suicidal risk;
  2. unstable mental state;
  3. were unable to participate independently in group activities; and
  4. exhibited disruptive behaviour

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Expanded Coming Out Proud group (ECOP)
In addition to Treatment as usual (TAU), the ECOP was conducted in collaborating community mental health centres over a 12-week intervention period, with one session per week, each lasting about 1.5 hours.
Behavioral: Expanded Coming Out Proud group
The ECOP consisted of 12 sessions, covering the following topics: sharing the experience of stigma (session 1); challenging social stigmatized beliefs (session 2); transforming self-stigmatized beliefs with CBT skill, e.g. guided discovery, pie-chart, behavioural experiment, (session 3-6); relaxation and social skill training on facing social stigma situations (session 7-8); reflecting the risks and benefits of secrecy and disclosure of mental illness (session 9); exploring the five levels of disclosure, which range from the lowest level of maintaining secrecy to the highest level of broadcasting one's experience with mental illness (session 10); learning to share own story with a mental illness (session learning to share own story with a mental illness (session 11); summary (session 12).
Other: Control group
Participants in the control group received TAU, including interest classes and leisure activities provided by collaborating community mental health centres, which were the same as those received by the intervention group
Behavioral: control group
Participants in the control group received TAU, including interest classes and leisure activities provided by collaborating community mental health centres, which were the same as those received by the intervention group

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Chinese Internalised Stigma of Mental Illness (ISMI)
Time Frame: From enrollment to the end of the treatment at 12 weeks, 3-month follow-up and 6-month follow-up.
The Chinese Internalised Stigma of Mental Illness is a 24-item self-report scale measuring changes in self-stigma, with good validity and reliability (α = 0.93; Young et al., 2016). The ISMI has been used in research studies on self-stigma (Lamarca et al., 2024). Each item (e.g., "I am disappointed in myself for having a mental illness") is rated on a 4-point scale, ranging from strongly agree (1) to strongly disagree (4). Item scores are averaged, with higher scores indicating greater self-stigma. As suggested by previous studies (Brohan et al., 2010), an ISMI score of 2.50 or above is regarded as high self-stigma, while a score below 2.50 is regarded as low self-stigma; this classification was adopted in this study.
From enrollment to the end of the treatment at 12 weeks, 3-month follow-up and 6-month follow-up.

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Chinese Beck Depression Inventory (BDI)
Time Frame: From enrollment to the end of the treatment at 12 weeks, 3-month follow-up and 6-month follow-up
The Chinese Beck Depression Inventory (BDI; Byrne et al., 2004) is a 21-item self-reported scale to measure participants' self-reported depressive symptoms with good validity and reliability (α = 0.91). Each item (e.g., Past failure) is rated on a 4-point scale with scores ranging from "0" to "3". The scores are summed over the items with higher scores indicating a higher severity of symptoms.
From enrollment to the end of the treatment at 12 weeks, 3-month follow-up and 6-month follow-up
Chinese Rosenberg Self-Esteem Scale (RSES)
Time Frame: From enrollment to the end of the treatment at 12 weeks, 3-month follow-up and 6-month follow-up.
The Chinese Rosenberg Self-Esteem Scale (RSES; Peng et al., 2024) is a 10-item scale to assess participants' self-reported self-esteem with good validity and reliability (Cronbach's α = 0.63). Each item (e.g., I feel that I have a number of good qualities) is rated on a 4-point scale with scores ranging from "1" (strongly agree) to "4" (strongly disagree). The scores are summed over the items with higher scores indicating better self-esteem.
From enrollment to the end of the treatment at 12 weeks, 3-month follow-up and 6-month follow-up.
Personal Empowerment Self-Assessment Scale (PESAS)
Time Frame: From enrollment to the end of the treatment at 12 weeks, 3-month follow-up and 6-month follow-up.
The Personal Empowerment Self-Assessment Scale (PESAS; Authors, 2013a) is a 10-item scale to measure an individual's perception of their own empowerment. The PESAS was developed as part of the Coming Out Proud with satisfactory reliability and validity (Authors, 2013a). In this study, the reliability of PESAS was found to be very good (α = 0.84). Each item (e.g., Having a mental illness doesn't mean I'm a bad person) is rated on a 5-point scale with scores ranging from 1 "strongly disagree" to 5 "strongly agree".
From enrollment to the end of the treatment at 12 weeks, 3-month follow-up and 6-month follow-up.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

City University of Hong Kong

Collaborators

Hong Kong Shue Yan University
Hong Kong Baptist University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

July 20, 2022

Primary Completion (Actual)

March 31, 2024

Study Completion (Actual)

December 31, 2024

Study Registration Dates

First Submitted

September 4, 2026

First Submitted That Met QC Criteria

September 4, 2026

First Posted (Actual)

September 10, 2026

Study Record Updates

Last Update Posted (Actual)

September 10, 2026

Last Update Submitted That Met QC Criteria

September 4, 2026

Last Verified

September 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 12609519

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

The data that support the findings of this study are available only from the corresponding author upon reasonable request and with the permission of the Research Ethics Committee of Hong Kong Baptist University.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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